OCCUPATIONAL MEDICINE, OCCUPATIONAL MEDICINE DOCTORS AND WORKERS’ COMPENSATION: INJURED WORKERS BEING TREATED OR EVALUATED IN AN OCCUPATIONAL SETTING: WHAT YOU NEED TO KNOW

In the field of medicine, there is a specialty that addressed work injuries, Occupational Medicine.

Many Injured Workers, during the course of their treatment or as part of their evaluation process, encounter doctors who specialize in the field of Occupational Medicine.  In sum, Occupational Medicine Doctors play a variety of roles in workers’ compensation cases. Occupational Medicine Doctors provide treatment to injured workers in the form of being Primary Treating Physicians.  Some of them also act in the capacity as Qualified Medical Evaluators.

Occupational Medicine is also known as Occupational and Environmental Medicine. Therefore, an abbreviation of OEM may come up with respect practitioners.   Further, there is an American College of Occupational and Environmental Medicine.  This organization represents various health care professionals in Occupational and Environmental Medicine.   The College has the abbreviation of ACOEM. Also, the College generates various publications such as the ACOEM Guidelines.  ACOEM Treatment Guidelines are used within the California Workers’ Compensation System.  It is a Board Certified Specialty.

This article will discuss Occupational Medicine, Occupational Medicine Doctors, the Role of Occupational Medicine Physicians within Workers’ Compensation and what Injured Workers should expect when seeing an Occupational Medicine Physician.

Is There a Controversy Concerning Occupational Medicine?

Occupational Medicine, in my opinion, is a controversial field.   The reason being is that, in the treating capacity, Workers only see Occupational Medicine Doctors when they have already had an industrial claim.

A book noted that it was “a disconcerting fact that workers’ compensation fails to compensate most occupational injuries and illnesses, including fatalities. Only a small fraction of occupational diseases is covered by workers’ compensation, and only a small fraction of people suffering from occupational illnesses ever receives workers’ compensation benefits. Either by law or by practice, compensation in many states is particularly limited for occupational diseases. A recent study suggests that workers’ compensation insurance absorbs only 21% of the true costs of occupational injuries and illnesses. Many workers’ compensation laws now prevent or discourage the recognition of occupational diseases. The efforts of many industries and their insurers to deny claims lead to the failure to compensate workers who have occupational diseases. Another important contributing cause is the limited information available to physicians.” The Practice of Occupational Medicine, LaDou, Harrison (2006).

In sum, because Occupational Medicine Doctors do not treat individuals who are initially coming in for regular treatment issues, they most likely never encounter individuals who have potential industrial injury cases. As a result, individuals will most likely not be  advised their treating doctor that their condition is work-related.  In this author’s opinion, the only way that Occupational Medicine Doctors can improve the rate of participants in the workers’ compensation for industrial injuries is to perform educational programs to General Practitioners or Family Medicine Doctors, In doing so, their knowledge of industrial injury causation would be passed on to front line treaters.

What Is Occupational Medicine?

Per the American Medical Association, “Occupational and environmental medicine… is the medical specialty devoted to the prevention and management of occupational and environmental injury, illness and disability, and promotion of health and productivity of workers, their families and communities.”

The AMA notes that “[t]he term “environmental medicine” …”addresses the impact of chemical and physical stressors on individuals and groups.”

What is an Occupational Medicine Doctor?

Per the DIR, Occupational Medicine Physicians “have knowledge in a number of clinical areas and expertise in a wide variety of disciplines. Occupational medicine focuses on comprehensively preventing and managing illness and injury among workers. An occupational medicine physician typically has expertise in:  The harmful effects of chemicals, metals, gases, and pesticides) and other workplace hazards, such as radiation and noise (Toxicology) Fitting the job to a person (Ergonomics) Musculoskeletal injuries including back, neck, and extremities Hearing loss Disorders of the lung, such as asbestosis, silicosis, and work-related asthma (Pulmonary) Work-related cancers (Oncology) Infectious diseases in the workplace, including blood borne pathogen exposures and tuberculosis Preventing illness and promoting wellness (Preventive Medicine)”

They can act in the capacity of QME.  Their QME code MPO.

Where Do Injured Workers Encounter Occupational Medicine Doctors? How Do They Operate?

In most circumstances, in the event of an injury in the workplace, many Employers will send workers to get treatment at an Industrial Clinic.   A number of Industrial Clinics employ Occupational Medicine Doctors to provide treatment.

Sometimes, Injured Workers may see Occupational Medicine Doctors in the capacity of QME.

In either circumstance, I have found that these doctors act as “gatekeepers.”  They appear to refer the Injured Workers out to the various medical specialties that are needed to treat or assess the various conditions.   In sum, they will refer Injured Workers out to necessary medical specialties such as orthopedics or internal medicine.   In my practice, they seem to point people in the right direction for treatment.   Also, they appear to be very capable of making an AMA impairment guide assessment at the most basis level.  By this, I mean that they are familiar with the various charts of the AMA Guides and are able to generate an impairment.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years.

WHY ARE WORK INJURIES NOT REPORTED?: WORK INJURY CLAIMS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

“To File or Not To File? That is the Question”

It is common knowledge that there are many work-related injuries that are not reported.   The lack of reporting denies the Injured Worker the opportunity to claim workers’ compensation benefits which may include disability benefits, medical care, and vocational rehabilitation benefits.

This article will discuss why both Employees and Employers don’t report work injuries claims. This article will also discuss whether there are times in which a claim should not be filed.

Why Is the Reporting of Work Injuries Important?

Pursuant to Labor Code Section 5402, a reporting of an injury triggers the obligation of the carrier to investigate liability for the claim and make a determination within 90 days.   Further, if the claim is not denied, a presumption of injury can apply.   Further, during the period of delay, the Applicant is entitled to receive medical care paid for by the carrier up to $10,000.00.

How Significant is Under-Reporting?

In the study, “[a] questionnaire and interview survey was administered to 110 workers performing similar tasks and several managers, health, and safety personnel at each of three industrial facilities. Although less than 5% of workers had officially reported a work-related injury or illness during the past year, over 85% experienced work-related symptoms, 50% had persistent work-related problems, and 30% reported either lost time from work or work restrictions because of their ailment. Workers described several reasons for not reporting their injuries,” . Under-reporting of work-related disorders in the workplace: a case study and review of the literature Pransy, Snyder, Dembe & Himmestein Pages 171-182 | Published online: 06 Dec 2010 https://doi.org/10.1080/001401399185874.

Note: In the study, significantly more Workers may have viable claims than those who report injuries.

Why Do Employees Under-Report Their Work-Related Injuries?

In a recent article, Employees reasons for not reporting injuries was discussed. Under-reporting of work-related disorders in the workplace: a case study and review of the literature Pransy, Snyder, Dembe & Himmestein Pages 171-182 | Published online: 06 Dec 2010 https://doi.org/10.1080/001401399185874. The reasons for the under-reporting were as follows: including fear of reprisal, a belief that pain was an ordinary consequence of work activity or ageing, lack of management responsiveness after prior reports, and a desire not to lose their usual job.

Fear of Reprisal: Note: Injured Workers are afraid that their Employers or Co-Workers can act in a negative fashion towards them if they report an injury.   Injured Workers are afraid that their pay, benefits, and work privileges and rights will be impacted.   Co-Workers can also be adversarial towards the Injured Worker if they are implicated in the injury claim. For example, they might be the cause of the injury claim as they may have stressed out or injured the worker.  Also, the Co-Workers may be a witness to the injury. The Co-Workers may not be happy that they are brought into the claim and have to make a statement against their Employer.   Note: Labor Code Section 132a protects Injured Workers and Employee Witnesses to claims.

A Belief that Pain was an Ordinary Consequence of Work Activity or Ageing: Note: Individuals with limited knowledge of medicine may not understand that certain medical conditions may be work-related.   This may be compounded by the fact that the Worker may not have sought treatment or medical care to be diagnosed with a condition.

Lack of Management Responsiveness After Prior Reports Note: Many times, injuries are reported and managers do nothing.  At that point, an Injured Worker just gives up.

 Desire Not to Lose Their Job Note: Certain Work Injury claims can impact one’s ability to work. Medical treatment or reporting may generate work restrictions that would preclude them from performing their job.   Also, there is the fear that they will be terminated for filing a claim.  Note: Labor Code Section 132a protects Workers against wrongful termination for reporting of a claim.

One reason not mentioned in the survey was

Worker not aware of their Rights to Claim Work Injury Note: Many workers are not aware of their workers’ compensation rights. Also, there are some injuries can be work-related that an Injured Worker would not know that they are work-related.

Why Do Employer’s Under Report Employees’ Work-Related Injuries?

In the article, it noted that “interviews with management representatives revealed administrative and other barriers to reporting, stemming from their desire to attain a goal of no reported injuries, and misconceptions about requirements for recordability.” Supra.

Desire to Attain a Goal of No Reported Injuries Note: Workers’ Compensation claims cost Employers money due to increased premiums.   For self-insured Employees,  there can be increased reserves because of claims.   In sum, work injuries cost Employers money.

Misconceptions about Requirements for Recordability Note: some Managers or Leads may not understand that what a work injury is and therefore not offer paperwork to the Injured Worker to file a claim.

Should an Injured Worker Report a Claim?

One should take thoughtful consideration when deciding whether to filing a claim.   They should think about whether it is worth filing the claim.  They should think about the implications in the workplace, and they should think about whether there is a medical/legal basis for filing the claim.  Consultation with an attorney is recommended to make the determination.   Further, a medical consultation might be of import as to whether there is industrial causation of the medical problem.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years.

Pain, Symptom Severity and Pain Reporting in Workers’ Compensation: What You Need to Know

In California Workers’ Compensation Law, there are many times that Injured Workers are asked to describe the nature and extent of their Pain. Injured Worker’s Pain Reporting is a vital part of the workers’ compensation system.  This article will discuss the terminology used within workers’ compensation to describe the nature and extent of pain. Pain Reporting is essential to the Workers’ Compensation System.  Pain Reporting can impact everything from the acceptance of the claim as being industrial, to the provision of benefits, and to the provision of medical care.

Pain Reporting can be subjective. People have different tolerance to pain. Pain can be different in nature. Pain can be dull. Pain can be sharp. Pain can be momentary. Pain can be unrelenting.  Further, many times it is hard for an observer to understand an individual’s pain. Due to the subjectiveness and the difficulty in verification, Pain Reporting has an element of doubt as to its nature and extent with respect to Insurance Companies.  All parties involved within the workers’ compensation, doctors, attorneys, and judges, will be assessing whether the Injured Worker’s Pain Reporting is valid for the purposes of handling the claim.

Injured Worker’s Pain Reporting validity impacts the very foundation of many workers’ compensation claims. Pain Reporting, for which Judges and Medical Evaluators view as credible, can lead to the provision of workers’ compensation benefits. This can include such items as the finding of injury being industrial to findings concerning the nature and extent of the injury. Pain Reporting, for which Judges and Medical Evaluators view as non-credible, can negatively impact one’s workers’ compensation claim.  This can include finding that there was no valid claim to the diminishment of benefits. Continue reading

What Insurance Companies are Telling Doctors to Think About You: Injured Workers, Your Treating Doctor, and Your Insurance Company: What You Need to Know

As an Injured Worker, you may come across terms such as “motivation factors,” “secondary gain,” and “victimization, ” noted somewhere within the reporting on your case. This can appear in a medical report or an analysis of your case that has prepared by an Insurance Company, Defense Attorney or an Investigator. Some of these reports, which use these terms, you will never see. The documents are generated as attorney work-product and are not discoverable. In addition, as an Injured Worker, you also may not see any medical reports that deal with your mental health. Psychiatric or Psychological reports that discuss these factors are not provided to unrepresented injured workers. Continue reading

How to Find the Best Workers Comp Attorney in California

In California, you see advertisements of attorneys making representations of being “Top” Lawyers, “Super” Lawyers,” or “Best” Lawyers. Attorneys frequently represent themselves as the “Top” attorney or the “Best” lawyer. Who can really tell someone is the “Top” or “Best” lawyer? At times, it is merely an advertisement’s representation without any basis in fact. Further, some of the companies that provide labels may involve some vetting process in order to provide the label. In the end, they may charge the attorneys for the label that they are awarded and make them pay for promotional items. Continue reading

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